It is observed that the results of collaborative models depend on a variety of factors, such as the capacity of the manager, the administrative environment, the conditions of the contract and adequate supervision by the financier.
The UCM research, which has also analyzed 500 scientific articles published throughout Europe, also confirms the absence of connection between subcontracting to private providers and the increase in avoidable mortality, as stated by Minister Mónica García in parliament.
Carlos Rus, president of ASPE, points out that “we cannot allow a law that destroys a historic and successful collaboration with citizen health and that becomes the law of 'No means no to the Patient' by dramatically increasing waiting lists. ”.
The research “Literature review of Public-Private Collaboration in Health: impact on health indicators” carried out by the Extraordinary Chair of Sustainable and Responsible Health of the Faculty of Commerce and Tourism of the Complutense University of Madrid, promoted by ASPE, concludes , with official public data, that public hospitals managed by private operators record, as a general rule, better indicators than the average of the hospitals of the Madrid Health Service in efficiency and patient care (global satisfaction index, global recommendation index and claims).
Consulting various sources - such as the Observatory of the Madrid Health Service, the audits carried out by the Audit Office of the Generalitat Valenciana or the publication of surgical waiting lists by hospital or health department - show that hospitals under this collaborative model They present better results than the average of public hospitals in most of the indicators analyzed.
The case of the Community of Madrid, as an example and as a relevant indicator in the main scope of the study carried out by the UCM, in the aggregate mortality rate, four of the five public hospitals managed by a private operator present the best mortality rates. the entire region. They are the hospitals of Infanta Elena, Rey Juan Carlos, Villalba and Fundación Jimenes Díaz. Its Standardized Mortality Ratio (SMR) is less than 1, that is, below what was expected. The fifth hospital, Torrejón, has an SMR of 1.
On the other hand, the two audits on Manises and Torrevieja by the Audit Office of the Generalitat Valenciana conclude that the departments of Manises and Torrevieja are two of the most efficient in the region and that they represent public health savings, registering achievement rates of objectives superior to all the hospitals in the Valencian Community.
In Torrevieja, the mortality rate for all ages and all causes per 100.000 inhabitants adjusted to the population is 822, while the regional average was 911 in 2015, below the average for the Valencian Community.
There is no scientific evidence that relates private healthcare to avoidable mortality.
Research from the Faculty of Commerce and Tourism of the UCM has carried out a detailed study of 500 scientific articles throughout Europe and does not find evidence that public-private collaboration increases avoidable mortality in Spain and other European countries.
This research makes special sense in relation to the political statements of Minister Mónica García who pointed out in parliament the existence of articles in recognized scientific publications that related public-private health collaboration with the supposed increase in avoidable mortality in health systems such as from the United Kingdom or Italy.
For ASPE, such statements have tried to undermine the collaborative model that the private sector provides in aid of public health, as allowed by the General Health Law in force since 1986, and in this way endorse the Law of Public Management and Integrity of the National System. of Health, whose parliamentary process has recently been announced, and which seeks to end health concerts and other models of public-private collaboration, despite the serious consequences it would have on citizen health and economic costs.
UCM researchers have analyzed in depth hundreds of scientific articles in Spain and neighboring countries with similar health systems, generating the most extensive and complete bibliographic research to date on the subject. The objective: to identify studies on the impact of public-private collaboration on mortality.
The two controversial articles mentioned by the Minister of Health
From the analysis of the article published in The Lancet on the British system (Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: an observational study of NHS privatization), the Spanish researchers point out that “it cannot be conclude a direct relationship between the increase in subcontracting to private providers and the increase in avoidable mortality.” It is observed that a large number of the data used to obtain the conclusion on the direct relationship between the increase in avoidable mortality and the increase in subcontracting have no relation to the outsourced healthcare activity.
In relation to the article in the Journal of Epidemiology and Community Health about the Italian health system (The effect of healthcare delivery privatization on avoidablemortality: longitudinal cross-regional results from Italy, 1993-2003), the Complutense research concludes that “the “avoidable mortality rate does not increase with a higher percentage of private sector provision.”
In addition, the researchers point out other additional general conclusions:
▪ At a general level (500 scientific articles analyzed), there is no evidence that public-private collaboration models obtain neither better nor worse results in health indicators than in the traditional public management model.
▪ There is a great diversity of factors that determine the operation and results of public-private collaboration models: “the real capacity of the manager, the legal personality, the administrative and institutional environment, the culture of the center, the conditions of the contract and the adequate supervision by the financier of the quality of the service provided by the manager.”
▪ The absence of reference data and the limited information available is a topic repeatedly indicated in the documents analyzed, making it necessary to have more and better data to obtain conclusive results.
▪ Most of the authors of the published articles and reports point out that the limitations existing in the data analyzed do not allow the conclusions obtained to be generalized or extrapolated to other territories or moments.
▪ Most of the existing documentation focuses on analyzing the different models from a legal and, especially, ideological point of view, with documentation for and against public-private collaboration.
Carlos Rus, president of ASPE, points out that “our health system cannot afford a law that destroys a historic and successful collaboration in favor of citizen health and that becomes the law of 'No means no to the Patient' by increasing the waiting lists are resounding.”
And he adds that ”the elimination of concerts will predictably and irresponsibly lead to a situation of worsening health in hundreds of thousands of users, by predictably increasing waiting lists, already at very high numbers. Public-private collaboration is the only alternative to alleviate this situation.”
